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Abstract
Episodic vertigo frequently occurs in patients suffering from transient ischemia in the distribution of the vertebrobasilar circulation (i.e., vertebrobasilar insufficiency). It may occur in isolation, with other symptoms of vertebrobasilar insufficiency or with persisting symptoms and signs of the infarction of the brain stem and/or cerebellum. Typical attacks of ischemic vertigo are abrupt in onset and last minutes. Ischemic stroke in the distribution of posterior circulation commonly develops acute onset of spontaneous prolonged vertigo and imbalance. As many as 25% of patients with risk factors for stroke who present to an emergency medical setting with isolated, severe vertigo, nystagmus, and postural instability have an infarction of the caudal cerebellum (i.e., pseudo-vestibular neuritis). Since the head thrust test can be performed at the bedside with no requirement of special equipments, it is invaluable for separating 'pseudo-vestibular neuritis' from true vestibular neuritis. Physicians who evaluate stroke patients should be trained to perform and interpret the result of the head impulse test. Since the inner ear is supplied by the vertebrobasilar circulation, inner ear symptoms are common with ischemia in the distribution. We briefly reviewed the clinical symptoms and neurological examinations of stroke presenting with vertigo, especially focusing on ischemic stroke of the vertebrobasilar territory.
Figures and Tables
Figure 2
Schematic view of connections responsible for saccadic lateropulsion. The climb-ing fibers originating from the contralateral inferior olive terminate in lobule VII of cerebellar cortex with an inhibitory action. In turn, these Purkinje cells in-hibit ipsilateral fastigial nucleus cells. Finally, the output of ipsilateral fastigial nucleus activates the contralateral paramedian pontine reticular formation, through the uncinate fasciculus.
1. medial medullary syndrome.
2. lateral medullary syndrome.
3. superior cerebellar artery syndrome.
Table 3
Symptoms from Vascular Infarcts in the territory of vertebrobasilar artery
ASCC: anterior semicircular canal, Dc: dorsolateral nucleus, HSCC: horizontal semicircular canal, INC: interstitial nucleus of Cajal, OTR: ocular tilt reaction, PSCC: posterior semicircular canal, Vce:Ventrocaudalis extrenus nucleus, Vim: ventroralis intermedius nucleus, VOR: vestibulo-ocular reflex
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